The mother of all prevention
Prevention of mother-to-child transmission of HIV
Sekela Kisambwe shifts little Claude from one side to the other as she talks to the doctor at the Lutheran Hospital in Itete, Mbeya. When the 17-month-old boy gets restless, Sekela lets him play around with her purse for a bit, and then offers him an orange soda. Claude is her youngest, a first boy after three daughters aged 13, 16 and 18 years from a previous marriage. Sekela is living with HIV, but her baby is HIV free, and she is taking all the right measures to keep it that way.
“Living with HIV is just a part of my life,” she says. When the mother of three adolescent girls got pregnant with Claude, she received advice from a Community Health Worker (CHW) on ways to keep the infection from transmitting to the child. Sekela made sure that she followed a special protocol to prevent infecting her child even before he was born.
“I was informed about the protocol for prevention of mother-to-child transmission (PMTCT) that starts from the time that I conceive, with HIV testing. When my test came back positive, I was put on antiretroviral drugs (ARV) immediately and this will continue for life,” said Sekela.
The goal of the antiretroviral therapy is to reduce viral load and boost the maternal immune system by increasing the amount of CD4 cells that fight infections, thus suppressing and preventing further replication of the virus, and therefore reducing the risk of transmission of HIV from mother-to-child during pregnancy, delivery and breastfeeding.
According to UNAIDS, there are 1.4 million people living with HIV in Tanzania, and 65,000 new infections were diagnosed in 2017. Mother-to-child transmission accounts for about 18 per cent of these new infections. The National Bureau of Statistics calculates that with more than 2 million births every year and the prevalence rate of HIV at 6 per cent among pregnant women according to the ANC Sentinel Surveillance Survey, approximately 120,000 HIV-positive women are estimated to deliver exposed babies. UNAIDS estimates that without treatment, 43,050 children born with HIV annually will not survive their first two years of life.
UNICEF supports the Government of Tanzania’s effort in the Mbeya, Iringa, Njombe and Songwe (MINS) region to reduce and ultimately eliminate mother-to-child transmission altogether with capacity building for services such as the CHW-to-hospital reporting, monitoring and coordination systems.
“I used my medication correctly and consulted health workers for advice,” says Sekela. Adhering to treatment enabled her to have a safe and normal delivery at a health facility, and the baby was born healthy. But testing negative at birth did not eliminate the threat of mother-to-child transmission and there was still a long way to go.
“Mothers must continue treatment and the babies who receive HIV prophylaxis are tested at regular intervals from birth to 12 months. Both cohorts are monitored closely throughout breastfeeding,” said Dr. Lee Mwakalinga, the hospital’s chief physician and director.
Sekela is living with HIV, but her baby is HIV free, and she is taking all the right measures to keep it that way. “Living with HIV is just a part of my life,” she says.
In Tanzania, the rates of exclusive breastfeeding for the first six months have doubled to 59 per cent over the past two decades, reflecting successful advocacy and implementation of early childhood development and nutrition programmes by UNICEF. But for HIV positive mothers, this practice carries some risk.
“The health benefits are enormous and indisputable, but breastfeeding can also be a channel of infection for babies to positive mothers like Sekela,” added Dr Lee.For this reason, he says, they “need to counter it from day one by ensuring mothers adhere to their ARV treatment throughout their pregnancy, and continue throughout nursing.”
Currently, in Tanzania, mother-to-child transmission rates stand at 3.6 per cent when a baby is six weeks old, but can double by the end of breastfeeding without monitoring and treatment. Therefore, retention is key to PMTCT, and UNICEF has been working to ensure that hospitals and community health workers work in close coordination to make sure mothers don’t drop out at a critical moment.
“We schedule tests in advance, monitor and report detailed information from communities to the hospital, which helps them to know exactly how many mothers and babies need to be monitored for PMTCT and when,” says Sikitu N. Kalukwa, a CHW in the area.
“If any of the mothers scheduled for monitoring and testing don’t show up for their appointment, the hospital informs us, and we follow up in the village.”
Currently, the Lutheran Hospital in Itete caters to six villages in the area with a population of over 9,000, and more than 100,000 people at the district level.
Babies of HIV positive mothers are advised to stop nursing at 12 months, which is when the final HIV test is held. If the babies test negative, they are declared HIV free. Sekela breastfed Claude exclusively for six months and weaned him at 12 months. He tested negative three times since birth, and the final test after 12 months confirmed that he was HIV free. Sekela says she wasn’t afraid to breastfeed, “I followed all the instructions.”
According to Sikitu, “Zero HIV altogether is an ambitious goal but zero transmission is doable through persistent education, counselling and support, services and strict adherence to the PMTCT protocol.” She wears messages on her clothing when moving around in her community. They carry slogans such as “wake up, mama,” and a call to pregnant women to get free HIV tests and services “for a better life.” The back of her shirt says “Zero HIV.” She has three positive mothers in her care, and all three babies have tested negative. “Maybe it is ambitious but it is possible. Three out of three babies are negative, this is 100 per cent for my community.”